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General NPI Number Information
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NPI Number | 1548293772
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Entity Type | Individual
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Provider Name | GEORGE W STOCKWELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 409 ROOSEVELT TRL
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City | WINDHAM
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State | ME
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Zip | 04062-4821
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Country | US
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Telephone | 207-893-0290
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Fax | 207-400-8633
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Provider Business Mailing Address
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Address Line | 144 STATE ST
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City | PORTLAND
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State | ME
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Zip | 04101-3776
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Country | US
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Telephone | 207-879-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1354
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License Number State | ME
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